1036 Rural Health Cancer Journey: Experiences of Stress and Sleep

Abstract Introduction Cancer is an unpredictable journey, and patients often experience side-effects from intensive therapies (e.g., nausea, dyspnea, cachexia, etc.) after leaving the treatment center. Rapid identification and treatment of side-effect symptoms is preferred. Rural family caregivers are tasked with patient symptom management at home often several miles (multiple hours) drive from medical services. Additionally, family caregivers report increased sleep fragmentation and prolonged sleep latency that may impact awareness of and confidence in managing patient symptoms. Poor symptom management has resulted in as many as 50% of patients delaying or refusing potentially lifesaving cancer treatments. This study explored the influence of sleep, mood, and perceived stress on family caregiver confidence in managing patient symptoms at home. Methods Caregivers and patients were recruited at a rural oncology clinic in a south-eastern state of the US. Each dyad completed the PSQI and ISI, PHQ-9, GAD-7, PSS during a single clinic visit. Additionally, family caregivers reported patient symptoms and their management confidence, while patients completed the FACT-G. Results 50 patients and 46 family caregivers participated in the study. Individually, family caregivers and patients reported moderate to severe PSQI, ISI, PhQ-9, GAD-7, and PSS scores. Patients generally reported worse anxiety, depression, and insomnia symptoms, while family caregivers reported slightly higher perceived stress. Significant correlations were observed between dyad members, with perceived stress (PSS) being the strongest [r= 0.59, p< 0.001] and depressive symptoms (PhQ-9) being the weakest [r=0.35, p+0.017]. Multiple linear regression revealed a significant amount of the variance in family caregivers’ symptom management confidence was accounted for by the combined sleep, anxiety, depression, and perceived stress predictors [R= 0.61, R2 = 0.37, F (5, 37) = 4.37, p=0.003, adjusted R2 = 0.29]. Conclusion Patients and family caregivers experience the cancer journey together. However, each member of the dyad reflects different impacts along the journey. Individual and dyadic experiences must be considered when developing interventions. Rural family caregivers must receive increasing support as patient symptom complexity increases to avoid negative outcomes from poor symptom management at home. Support (if any) Intra-mural university funding